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Clinical results and functional outcomes after three-column osteotomy at L5 or the sacrum in adult spinal deformity

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Abstract

Purpose

Three-column osteotomies at L5 or the sacrum (LS3COs) are technically challenging, yet they may be needed to treat lumbosacral kyphotic deformities. We investigated radiographic and clinical outcomes after LS3CO.

Methods

We analyzed 25 consecutive patients (mean age 56 years) who underwent LS3CO with minimum 2-year follow-up. Standing radiographs and health-related quality-of-life scores were evaluated. A new radiographic parameter [“lumbosacral angle” (LSA)] was introduced to evaluate sagittal alignment distal to the S1 segment.

Results

From preoperatively to the final follow-up, significant improvements occurred in lumbar lordosis (from − 34° to − 49°), LSA (from 0.5° to 22°), and sagittal vertical axis (SVA) (from 18 to 7.3 cm) (all, p < .01). Mean Scoliosis Research Society (SRS)-22r scores in activity, pain, self-image, and satisfaction (p < .05), and Oswestry Disability Index scores (p < .01) also improved significantly. Patients with SVA ≥ 5 cm at the final follow-up experienced less improvement in SRS-22r satisfaction scores than those with SVA < 5 cm. Patients with LSA < 20° at the final follow-up had significantly lower SRS-22r activity scores than those with LSA ≥ 20° (p = .014). Two patients had transient neurologic deficits, and 11 patients underwent revision for proximal junctional kyphosis (5), pseudarthrosis (3), junctional stenosis (2), or neurologic deficit (1).

Conclusions

LS3CO produced radiographic and clinical improvements. However, patients who remained sagittally imbalanced had less improvement in SRS-22r satisfaction score than those whose sagittal imbalance was corrected, and patients who maintained kyphotic deformity in the lumbosacral spine had lower SRS-22r activity scores than those whose lumbosacral kyphosis was corrected.

Graphic abstract

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Acknowledgements

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA

    Haruki Funao, Floreana N. Kebaish, Richard L. Skolasky & Khaled M. Kebaish

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  1. Haruki Funao
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  2. Floreana N. Kebaish
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  3. Richard L. Skolasky
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  4. Khaled M. Kebaish
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Correspondence to Khaled M. Kebaish.

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Funao, H., Kebaish, F.N., Skolasky, R.L. et al. Clinical results and functional outcomes after three-column osteotomy at L5 or the sacrum in adult spinal deformity. Eur Spine J 29, 821–830 (2020). https://doi.org/10.1007/s00586-019-06255-z

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  • DOI: https://doi.org/10.1007/s00586-019-06255-z

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